Sarah Ryan learned the hard way about the importance of self-care for mental health as a new mother.
It was only on her second pregnancy that she was diagnosed as having had postnatal depression after the birth of her first baby five years ago. Having suffered from hyperemesis gravidarum – extreme nausea and vomiting – on both pregnancies, it was worse the second time around.
“I was basically on house rest for eight months, which, as you can imagine, is an incredibly isolating experience.”
Women with hyperemesis are at greater risk of postnatal depression so, on her second pregnancy, she was referred for psychological support. There she learned that what she had struggled with after the arrival of her first child in 2014 was depression.
The usual anxiety of a first-time expectant mother was exacerbated by the fact that she was booked into Mount Carmel hospital in south Dublin, which was then scheduled to close the week her baby was due. Her son, Conor, was one of the last babies to be born there. She and her husband had also moved house during the pregnancy.
“I was told afterwards that there was just so much going on, it was probably the stress of that that led to the postnatal depression.”
However, she also believes that, like many first-time mothers, she had unrealistic expectations and felt huge pressure to appear to be the perfect mum. She partly blames the media for that but also thinks we all have to take responsibility as users of social media.
“We do only post the perfect moments on social media and we don’t share the challenging ones. Even if someone asks you how you’re getting on, you say: ‘Ah, fine.’” She found when telling friends afterwards that she had had postnatal depression, they would say they thought she was the one who “had it together” while they felt inadequate.
If women were more honest about how difficult new motherhood can be, it would “lower the bar” and give others a more realistic expectation, she suggests. “Most of us don’t sleep when the baby is sleeping. You’re running around trying to get a load of laundry on or throw a stew in the oven and leave yourself so down the priority list that a lot of mums burn out, because they haven’t looked after themselves at all.”
Self-care in early motherhood comes in many forms, ranging from doing small things for yourself to seeking support of family and friends to asking for help from health professionals.
Krysia Lynch, chair of the Association for Improvements in the Maternity Services – Ireland, says her number one tip to new mothers is "under no circumstances get yourselves out of your pyjamas for the first two weeks".
If you’re having visitors, this sends out the signal to them that you deserve to have a cup of tea made for you, whereas if you are fully dressed, they will expect you to put the baby down and make them a cup of tea.
While acknowledging she is saying this slightly tongue-in-cheek remark, she believes it is important to educate relatives of new mothers that they are not calling around to hold the baby, “you are coming down to support the mother to hold the baby”.
Yes, the mother may ask you to hold the baby while she has a shower. But she might need you to make her a meal, put a wash on, sweep the floor or fill the dishwasher, while she’s with the baby.
Historically, maternity care in Ireland has been very much focused on the baby, says Lynch, “sometimes to the detriment of the mother”.
The standard six-week check-up for mother and baby is supposed to be the signing off of the postnatal period. The maternity hospital’s duty of care to you and your newborn finishes 42 days after you have delivered, she explains.
But women’s feedback on what happens at that six-week check-up suggests there is huge variability in what it covers. Private patients have that appointment with their obstetrician, who will usually have recommended a private paediatrician to check the baby.
However, the vast majority of mothers are in the public health system and will have the six-week check with their GP, under the auspices of the Infant and Maternity Scheme.
“You are supposed to be cared for as well in that check. Women report back that the baby gets the full check and they very rarely get asked questions about themselves and their own well-being.” As well as having your physical health checked and discussion of whether or not you need to resume the use of contraception, there is the “how are you feeling in yourself?” question.
It’s a loose kind of question, she points out. The sort of euphemism that can go right over the head of the sizeable minority of women giving birth here for whom English is not their first language.
About one in five mothers in Ireland suffers from postnatal depression but lack of awareness about what is and isn’t “normal” means it may go undiagnosed. The same applies to physical ailments stemming from giving birth such as incontinence, pelvic girdle pain and sexual problems.
The extent of birth-related problems among Irish women that go unreported has been highlighted by the Maternal Health and Maternal Morbidity in Ireland (Mammi) study. Of the 2,600 first-time mothers surveyed, one in three said they still had pelvic girdle pain three months after giving birth, while half of them had experienced painful sex and a quarter had not resumed sex. Almost 60 per cent reported having leaked urine since giving birth and 12 per cent had had anal incontinence.
As for their mental health, 28 per cent reported feelings of anxiety, while 18 per cent had experienced depression at some stage since giving birth.
Stopping maternity care six weeks after birth is far too early, says the leader of the Mammi research team, Dr Deirdre Daly, assistant professor in midwifery at Trinity College Dublin. It takes most women two to three months to start to find their feet with their first baby and she would like to see standard healthcare including every new mother being asked by a health professional at three months: "How are you?"
Instead, as the Mammi study shows, at six weeks, often relevant questions are neither raised by the health professionals nor asked by the patients who know no better. It found that two-thirds of GPs did not ask the mother about pelvic pain, 80 per cent did not inquire about sexual health problems and half failed to inquire about depression or anxiety.
As a result, there’s a “cycle of silence”, says Daly, in which women suffer from complications which should be addressed. “If we look after the mothers, the families will be well too.”
A new paper from the study, due to be published this month, shows how many of the first-time mothers benefited from taking part in the research because it helped inform them of what was and wasn’t normal. This prompted some to take better care of themselves or to seek professional help. It also gave them a chance to reflect on their own experiences.
“I have learnt a lot of things . . . thanks,” notes one woman. Another says the surveys “have highlighted for me the huge gaps in my knowledge regarding postpartum care for myself”. Adding that she also has gaps in her memory of labour and childbirth, she suggests that a “debrief” at three or six months might benefit new parents.
Being proactive about such a debrief is an element of self-care that Lynch recommends for those who might have issues with what happened in the delivery room. “If you felt childbirth was difficult for you then you should really talk about it with somebody.” If you don’t, she adds, “it’s all going to come up next time you get pregnant or something earth-shattering happens”.
Even after the most straightforward birth, the early weeks and months caring for a baby are still likely to be very challenging. The parent-to-parent (P2P) support organisation Cuidiú is there to help particularly those who are coming to parenthood for the first time and feeling overwhelmed, says its president, Nicola Reeves.
“Self-care is very hard to do by yourself and the support is there,” she says. Cuidiú’s message to new parents is that “you don’t have to do this on your own”.
“Our encouragement in early days would be to draw on the support you already have. A lot of mums that come to us are separated from their own family networks and we can fill the gap.”
She stresses that breastfeeding support is only one part of what they do. She would hate to think that any mother would feel she was being judged on the basis of how she chooses to feed their baby.
Those who are really struggling with parenthood can seek information and avail of one-on-one advice from the trained volunteers who operate a P2P support service. Most branches around the country have at least one P2P volunteer.
There are also monthly P2P meetings, Reeves adds, geared at people who are finding it hard to cope, “or just wondering are they finding it hard to cope”.
Ryan found it was making very small windows of time for herself that helped her to cope with the unrelenting selflessness of new motherhood. “I didn’t feel I should be taking time for myself, I felt I should be giving everything to my family.”
Finally, when she started doing small things, such as enjoying a hot cup of tea in a different room while reading a book or doing gratitude journaling, it gave a significant boost to her mental state. “Even taking 10 or 15 minutes for yourself on a daily basis makes a huge difference. That is something that I think it took me a long time to learn.”
As a result, she has started a business, Mama Moments, to help other women do the same. It's a subscription service for a bimonthly gift box of five or six items, for example skincare products, chocolate and herbal tea, designed to encourage mothers to practise self-care.
Acknowledging that “self-care means different things to different people”, she is however a firm believer that you “need to do something for yourself every single day”.
Brand for mothers born out of struggles of new motherhood
Finland has been voted the best country in the world for mothers but even there women can struggle with the impact of childbirth and motherhood.
Finnish-born Laura McGrath (41), who is married to Irishman Robbie McGrath, found it a “complete shock in all possible ways”. She had gone into the Helsinki maternity hospital to give birth seven years ago, expecting pain but resolving to be brave.
“No part of me imagined that soreness had nothing to do with it, but that it was going to be a matter of life or death instead. I didn’t realise it was such a serious business, I was kind of naïve,” she laughs.
Although her son, Onni, was delivered safely she was unlucky to have severe complications, which kept her in hospital for two weeks after his birth. It was hardly the best start to motherhood.
She had a standard three-month check-up but thought it was totally inadequate for what she had been through. You are asked about your mental health, she acknowledges, but “it is difficult to describe the feeling: lonely of course, but also being bewildered – you have no idea of what is happening and what the future looks like. It really throws you off course.”
McGrath attended a few meetings of a local mothers’ group but “they made me feel horrible instead of good”. The discussions were around things such as how many lullabies they knew the lyrics of.
Determined to do things her own way, she couldn’t stand the picture of perfection she felt they were holding up, with the idea that “the baby is pure and you have to do everything right and breastfeed all the time”.
Although she and her husband started trying for a second child when Onni was two, it was five years and one miscarriage later before their daughter Ella was born two years ago.
Laura has also had physical problems with her neck and back, which she reckons are fairly common symptoms for a new mother, “because you are not really minding your posture and you are up all night and you are not really looking after yourself”.
It was her maternal experiences and also those of her childhood friend, Kati Hovikari (38), that gave them the idea of starting a business last year aimed at helping to resolve women’s postnatal problems.
After Kati had her son six years ago, she had ongoing issues with her posture and back pain and ended up losing her job. Doctors couldn’t pinpoint the problem and began to think “there was something wrong in her head”, says Laura.
Finally, after two years, it was realised she had separated abdominal muscles that had never recovered from the pregnancy and she needed surgery.
Their Lola&Lykke brand's first products include a core restore support band and a thermal boob tube which is geared towards more, perhaps, to breastfeeding women in the Nordic countries. Another important element is a blog on the website in which they want to give new mothers honest, factual information about both the physical and mental challenges they may face, and encourage them to look after themselves as well as the baby.
“What we want to create through this business is a sensible voice saying that it is okay to have your own demands and it is okay to feel what you are feeling,” Laura adds. “You don’t have to be perfect.”